=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730055542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KANEKO HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 823 S. ATLANTIC BLVD., SUITE #5
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-741-8229
-----------------------------------------------------
Fax | 626-458-3736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 823 S. ATLANTIC BLVD., SUITE #5
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-741-8229
-----------------------------------------------------
Fax | 626-458-3736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHINOBU KANEKO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-463-0736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------